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General NPI Number Information
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NPI Number | 1235852468
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Entity Type | Individual
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Provider Name | CHRISTOPHER KYLE OWEN
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Gender | Male
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Dates
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Enumeration Date | 09/22/2022
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Last Update Date | 09/22/2022
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Provider Practice Location Address
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Address Line | 3005 BOARDWALK ST STE 201
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City | ANN ARBOR
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State | MI
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Zip | 48108-5218
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Country | US
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Telephone | 734-222-9277
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Fax |
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Provider Business Mailing Address
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Address Line | 3164 ANN ARBOR SALINE RD APT 204
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City | ANN ARBOR
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State | MI
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Zip | 48103-9858
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Country | US
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Telephone | 484-356-8535
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 6352000733
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License Number State | MI
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